Dental Emergencies

Dr. Shibuya gives a brief talk on dental emergencies (08/08/2017)

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Lecture Notes

Dental Fracture

• Ellis Class I: Enamel only
  • Not associated with dental pain
  • Sharp corners may irritate oral mucosa
  • Management: Nonemergent referral to dentist for aesthetic repair
• Ellis Class II: Involves dentin
  • 70% of dental fractures in adults
  • Hazy yellow or pink visible in fracture site
  • Symptoms: Hot/Cold sensitivity and pain
  • Management: Cover exposed dentin with temporary dental cement (Denttemp)
    • Referral to dentist within 24 hours
    • Penicillin VK 500 mg PO qid (or clindamycin 300 mg PO qid)
• Ellis Class III: Involves Pulp
  • Red tissue visible in fracture site. Blood or tissue present if wiped with gauze.
  • Hot/cold sensitivity and pain
  • Management: Cover exposed pulp with calcium hydroxide base (dycal) then cover with Dentemp
    • Referral to dentist within 24 hours
    • Penicillin VK 500 mg PO qid (or clindamycin 300 mg PO qid)

Dental Avulsions

• General considerations
  • Obtain chest x-ray if location of tooth is unknown due to risk of aspiration
  • Consider obtaining a CT of the face/jaw if suspicion for fractures after careful maxillofacial and pharyngeal examination
  • Tetanus vaccine if tooth was on the ground
  • Goal: Reimplant with 2-3 hours of avulsion
  • Do not replace avulsed primary teeth in pediatric patients
    • May fuse to alveolar bone and alter development of adult teeth.
  • Management in the ED
    • If patient did not reimplant tooth in the field, immediately place tooth in an isotonic solution.
      • Hanks solution preferred, but normal saline or milk are also acceptable
      • Water and saliva are hypotonic and are less preferable
    • Gently irrigate tooth with normal saline
      • Hold tooth by crown as touching root can damage dental ligament
    • Apply local anesthesia around socket
    • Irrigate socket with normal saline to remove clot
    • Place tooth in socket
    • Apply dental splint
      • Wire splint, moldable splint, or aluminum foil
    • Aftercare
      • Follow up with dental within 24 hours
      • Doxycycline 100 mg po bid

Dental Caries

• Loss of enamel due to acid produced by bacteria
• Defect through enamal: Sensitivity to cold/heat
• Defect through dentin or pulp: Pain and gingival inflammation
• Management
  • PO Analgesia
  • Penicillin VK 500 mg PO qid (or clindamycin 300 mg PO qid)
  • Referral to dentist

Postextraction Bleeding

• Pressure with folded 2×2 gauze pad x 10 minutes
• Cellulose packing (surgical)
• Lidocaine with epi
• Silver nitrate
• OMFS consult if all else fails

Resources

Tintinalli, Judith E, Gabor D. Kelen, and J S. Stapczynski. Emergency Medicine: A Comprehensive Study Guide. New York: McGraw-Hill, Medical Pub. Division, 2011. Print.

Benko, Kip. Acute Dental Emergencies in Emergency Medicine. Emergency Medicine Practice. Volume 5(5).

Guthrie, Kane. “Dental Trauma and Emergencies”. 2010. Life in the Fast Lane. https://lifeinthefastlane.com/minor-injuries-004/

 

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